Today, when parents express a concern about their youth’s behavior, mood or attention span to a physician, typically within a matter of minutes this expressed concern is translated into a mental illness conceptualization using the DSM. The parents are then sent on their way, prescription in hand.

For those of us who believe that there is something seriously wrong with this DSM medical model approach, the question that naturally arises is, what’s the alternative? In an earlier DxSummit post I provided an alternative that would replace the DSM’s pathologizing of individuals with a more scientific approach of classifying expressed concerns. But once we finish with the classifying, what alternative to the psychiatric drugging of our youth can we offer? Counseling and psychotherapy are often the main proposed alternatives mentioned. Although helpful for many cases, my post today puts forth a vision for an alternative when something more is required.

The One-On-One Program

The best way to introduce the One-On-One Program is with two brief parables. They will help to give the reader an intuitive understanding of how the program can address some of the most challenging concerns that many parents and community members face on a daily basis.

The Parable of Tony

Our tale begins when Tony is 12-years old. One day Tony’s mother, Nora, busy at work, is called by the police. Apparently Tony, just outside of the neighborhood afterschool center, was being teased by the other kids as being a baby.

“Baby, baby!” they taunted him over and over again.

When he chased after them, they ran inside the center, shut the glass door behind them, and while holding the door shut, they continued to taunt him through the door.

“Baby, baby!”

“Let me in!” Tony cried! “Let me in!”

“Tony is a baby! Tony is a baby!”

At this point, Tony picked up a rock and smashed the glass door.

When Nora and Tony get home from the police station, she starts hollering. “You know I have to work until six, Tony! Now the afterschool center says you’re not permitted to return! From now on, after school you’re to go straight home! If you get into trouble, I’ll beat the living daylights out of you!”

A few weeks go by and then once again Nora gets a call from the police. This time a gang in the neighborhood had enlisted Tony to be a lookout while they slipped into homes and stole anything that looked valuable. Tony explained afterwards that the gang members agreed to stop doing mean things to him if he cooperated with them.

Although threatened by a judge that another offense would lead to a stay at a juvenile detention center, Tony claimed that he thought that would be cool. Nora began to feel helpless.

When the school counselor called to report that Tony was having trouble at school, she asked him what she could do under the circumstances.

“Isn’t there someone from your family who can watch him after school lets out?” he asked.

“To get a job, I had to move here,” she replied. “My family lives hundreds of miles away. I can’t afford to hire someone to work with him one-on-one every day after school.”

“We have a program at our high school called the One-On-One Program,” said the counselor. “I can find a high school student who could help you out. You’d have to pay him something based on a sliding scale basis. For your income bracket it would cost you about the same amount that you paid for the afterschool center that Tony got thrown out of.”

“That’d be great!” Nora replied.

Nick, 17-years old, began to meet Tony every day after school at his high school. They began with a mile walk. Then together, both worked on their homework for a half hour. Nick used the rest of the time he spent after school with Tony to find some skill that he could help Tony develop.

What a difference this plan made! Nick found the way Tony looked up to him very rewarding and he got a great satisfaction knowing he was helping. The mile walk each day did Tony and Nick’s health a world of good. By doing his homework each day, Tony’s grades improved. His teacher also reported that the afterschool attention he was getting clearly improved his conduct in the classroom. He was no longer wildly driven to get her attention and he was far less likely to blow up in anger.

For talent development, Tony showed an interest in chess, so both boys began to play every day after school and his mother bought a book to help improve their game.

As helpful as the plan was for Nick and Tony, perhaps helped most of all was Nora. The stress from getting called at work by the police department completely went away.

Tony now got home a full forty minutes after her. During that time, Nora closed her eyes, and often fell asleep for a half hour. By the time Tony got home, Nora had enough time to get supper on the stove. When Tony would join her in the kitchen to tell her how his day had gone, she enjoyed the interaction, whereas before she felt drained and found she quickly became annoyed.

“The plan restored me to sanity!” she often would tell her friends. “I have so much more patience with Tony!” she cried when her own mother called one day to ask how things were going.

The next school year, Nick went away to college, so Nora was concerned about finding someone to replace him. But Tony heard that his junior high had started an afterschool chess club. He wanted to give it a try.

To his delight, Tony found that after a whole year of playing chess with Nick five times a week, he had become pretty good. He was able to beat several of the players, and most of the other players were about at his skill level. Even the best players respected Tony’s skills because he knew enough to make it a challenge to win.

Best of all, several of the players began to call Tony to play chess on the weekend or to go to a movie with a few of the other guys. Soon, he had, for the first time in his life, some real friends.

Parable Discussion

For some, once a week counseling can make a significant difference. But in some cases, children see a counselor once a week and then go home to parents who are so stressed out at work that they frequently lose their temper. The resulting angry parent-youth interactions may very well offset any gains that may occur during counseling.

Other children have parents working two jobs to make ends meet. When these children go home after school they rarely find needed one-on-one time. Some of these children then seek closeness with street gangs who can provide daily close human contact, but at the expense of criminal behaviors.

In addition to the acting out type of problem that is characterized in the parable of Tony, there is another type of problem that professionals sometimes come to realize requires something more than what they can currently provide in a weekly hour session.

The Parable of June

June is 11- years old and wearing a cute pink dress. She has been brought to see Dr. Goleman, a psychologist in his mid-forties. Wearing gold rim glasses, and a white collared shirt, Dr. Goleman is leaning forward on his desk, clearly very concerned.

“I’ve been awfully sad, and she hates it when I cry out that I hate myself,” June replies. “I can’t help it.”

“Wow! Do you know why you are feeling so blue?”

“I’m terribly lonely.”

“Lonely? Hmmm. You go to school where there’re lots of kids your own age. You could go to the afterschool program where you don’t have to be lonely. Your mother told me that you refuse to go there. What’s up with that?”

“At school and at the afterschool center I feel lonelier than when I’m alone. The kids make fun of me there and when a teacher tells the other kids to include me I can tell they wish they weren’t stuck playing with me.”

“I see,” replies Dr. Goleman. “Sometimes, June, it feels lonelier when you are with people than when you’re alone. Do you also feel lonely when you are alone?”

“Terribly.” Tears begin to form in June’s eyes.

“I can see that you are feeling sad now,” says Dr. Goleman softly.

“I get like this a lot.”

“Are there any times when you don’t feel lonely?”

“Yeah, when my cousin Marissa comes for a visit. She’s a few years older than me, but she really likes talking to me. And I play the flute and she plays the piano, so we play duets together, and we love being together. It’s just that she lives up in Rochester and so I only see her once every month or two.”

“So, when you’re with Marissa you don’t feel lonely.”

“Not when we’re together. She’s like a big sister to me.”

“I see,” says Dr. Goleman. “June, we have a program in this community called the One-On-One program. If you join the program, a high school student would do some fun stuff with you every day after school. Every day when you finish with school the bus would take you for a five-minute ride to the high school where your high school buddy would meet you. You would take a little walk with your buddy. Your buddy would ask you how your day went and listen to you. Then both of you would do your homework together, and then you could play music together. Would that be fun?”

“Does my buddy play the piano?” asks June.

“Hmm, let me look on this list. We don’t have any piano players, but I see we have a seventeen-year old named Rachel who plays the guitar. She would love to do duets with you every day after school.”

“Really?! She’d be like a big sister!” June is clearly beginning to brighten up.

“The kids in the program usually love doing stuff together,” says Dr. Golden. “The nice thing about it is if it doesn’t work out, you don’t have to go any more, or we can find someone else you can try working with.”

“Boy, I’d love to try something like that out! When can I start?!” A delightful smile is now gracing June’s lovely face.

Parable Discussion

As this Parable illustrates, in addition to children and teenagers getting into trouble with the law, there are others who need a different type of help than what can be accomplished by a weekly visit for counseling. Over the years that I worked with students, whenever I realized my services would not be enough, the eight interventions I thought about were:

Mentoring.

Intensive after-school supervision.

Activities designed for development and extensive practice in an area of interest.

The development of nurturing relationships between older and younger students.

Development of meaningful after school activities.

Homework coaching by high school and college students.

Teaching emotional intelligence and conflict resolution first to high school and college students who will then teach it to students at least four years younger.

Daily journal writing activities.

Implementing these interventions has proven to be very difficult within most communities. Let’s look at mentoring as an example.

A brief summary of the empirical evidence for mentoring can be described as follows. Tierney, Grossman, and Resch (1995) conclude that the mentored children they studied were 46 percent less likely than controls to initiate drug use during the study period; 27 percent less likely to initiate alcohol use; almost one-third less likely to hit someone; skipped half as many days of school; skipped fewer classes; and showed gains in their grade point average. Davidson and his colleagues (1987) have shown that a mentoring program in which college undergraduates were trained and supervised to be mentors of adjudicated delinquents reduced the chances that they would be again arrested by 34%, resulting in a savings of nearly $13,000 in criminal justice and victim cost per youth receiving the program.

Even though there is this extensive body of research indicating that mentoring is effective, programs carried out in the manner typical for a community only benefit the very few who get this service. Because of the shortage of available volunteers, in most cases it takes well over a year to match up a pair. Waiting lists tend to be very discouraging. Most families seeking a mentor do not receive help. By the time help arrives much damage has already needlessly occurred.

And so, how can a community provide all of the effective services that research studies indicate are effective in an affordable manner? The One-On-One Program, I believe is the answer.

How the One-On-One Program Would Work

The One-On-One Program begins with providing a semester course to high school and college students that provides lessons on basic counseling and how to teach conflict resolution skills. Those students who are successful in the course can apply for an internship. High school student interns earn a two-dollar an hour stipend, high school credit, and a recommendation from the program supervisor, while college student interns earn a four- dollar an hour stipend, college credit, and a recommendation from the program supervisor. Interns work one-on-one with students at least four years younger than they are after school daily from 3:00 to 6:00 p.m. at local high schools. Supervision is provided by mental health service providers and volunteer senior citizens. All interns and intern supervisors go through a background police check. The intern-younger student pair is matched through a survey indicating that they have similar interests and talents. Interns, when mentoring, participate in a credit bearing class designed to help them to resolve problems that arise when working with their younger partner.

Because interns will miss some days for sickness or personal reasons, three rovers per high school will come to work once a month in order to meet regularly with all of the younger partners. This allows the participants to feel more comfortable working with a rover whenever their buddies are absent. The three rovers are on call the rest of the month to fill in when needed.

Daily activities for each pair include:

1. a mile walk while the intern employs basic counseling skills of empathy and reflective listening,

2. participation in a mutually fun half hour activity, while a nutritious snack is provided,

3. forty-five minutes doing homework,

4. fifteen minutes of journal writing wherein the students write about pleasant experiences one day and distressing experiences on the next. For students who are not developmentally capable of writing journals, art activities designed to explore pleasant and unpleasant experiences are substituted,

5. a recreational activity mutually decided upon and designed to develop the interests and talents of both members of the intern-student pair,

6. since on Fridays whenever homework is given to a student it can be done later over the weekend, instead of using the usual forty-five minute homework period to do homework, a conflict resolution lesson is taught by the intern to the younger student.

The One-On-One Program Addresses Five Concerns

Lack of an adequate supply of mentors

Lack of adult supervision

Stigma

Placing at-risk kids together in interventions that makes a bad situation worse

Too costly for strapped community resources

Let’s take a closer look at these five concerns

Lack of an adequate supply of mentors. As mentioned above, in most communities there are far too few mentors who volunteer to help struggling children. The One-On-One Program provides three incentives beyond what is ordinarily offered to volunteers—a salary in the form of a stipend, course credits, and a recommendation from the program supervisor that can be used for future education and employment opportunities. In a survey that was conducted in Corning, New York to determine the viability of the One-On-One Program, 855 high school students and 490 Corning Community College students heard a description of the program and then anonymously filled out a questionnaire asking if they would agree to work toward becoming an intern if the program was now available. From these findings we can estimate that for every one thousand students, approximately 120 would agree to work toward becoming an intern. This number was very similar for both high school and college students. Keep in mind that not all students who begin the process of becoming an intern would successfully reach the point at which they would become an intern. Nevertheless, if even half succeeded, each community would be able to generate a group of several hundred mentors who would be willing to help provide extensive supervision after school let out.

Adequate adult supervision that allays express concerns by some community members. In contrast to the typical babysitting arrangement, the program would have two adult supervisors present at all times. Although an adult supervisor cannot be in sight of every student every minute, their role would be to keep circulating and popping up every few minutes. Student participants would be told that they could only go to certain areas of the high school that is designated as part of the program site, and at any minute a supervisor could appear. In focus groups, I found that community members felt that reasonable protection would be provided to all participants with this level of supervision.

Stigma. Some parents who participated in focus groups expressed a concern that if only “at-risk” students were to receive help from interns, all students involved in the program would become stigmatized as an “at-risk” youth. Other parents who did not have a child who was traditionally viewed as “at-risk” made the case that their children should have access to the intern services. Some said they would be willing to pay for this type of service out of their own pockets. These parents pointed out that their children come home from school and spend the entire time from three to six p.m. sitting in front of either the TV or computer watching violent shows or playing violent video games. With no exercise, they were becoming overweight and at risk of health problems. With the One-On-One Program, their children would get exercise, a structured time to get homework completed, help in developing a talent, instruction on conflict resolution, and real life social interactions. “Why shouldn’t these types of children also get help from the One-On-One Program?” some argued. To address these concerns, the design of the program was changed so that any family would be able to participate in the program by paying a sliding scale fee. The juvenile courts would pay for the cost of diverting appropriate youths from imprisonment, and special education departments would pay for students whenever their decision makers felt that such a program should be tried before students were placed in a special education class. It would remain confidential which students are subsidized in the program, and which pay a full fee, so that no one can assume participants are “troubled,” from low income families, or just desiring the fun of participating in the program. Although the program would have an open enrollment policy, principals, counselors, teachers, social workers, psychologists, police officers, parole offices and judges would be on the lookout for students who appear to be developing difficulties related to a lack of supervision and would refer them to the program.

Placing at-risk kids together in interventions makes a bad situation worse. Today, at-risk students are typically placed together to provide some intervention in a group, such as a special classroom, or a center for juvenile delinquents. These students then begin to encourage the other youths in the program to get into more and more trouble. Accumulating evidence has been demonstrating that such intervention programs indeed oftentimes increase delinquency, substance abuse, violence, and adult maladjustment. (Arnold, et al.1999; Dision, et al, 1999) The One-On-One Program avoids this problem by having the at-risk youth interact not with other at-risk kids, but an older trained intern.

Too costly for strapped community resources. Programs that have the at-risk youths interacting together are not only oftentimes less than effective, they are also oftentimes an expensive waste of money. The added cost of educating a student in a local “alternative” classroom or school is in excess of $13,000 per year. The cost of keeping a single child in a residential facility as a result of family or criminal court action can cost over $30,000 annually for a minimum-security group home, and over $300,000 for a maximum security facility. The cost of violence perpetrated by young people on other young people, as well as other populations, is not only enormous in financial terms, but devastating in social terms. To provide the level of services that the One-On-One program would provide (15 hours a week of direct one-on-one after-school supervision and 5 hours of planning, record keeping, and follow-up) would cost a minimum of $750 per week per child if a professional provided the mentoring. The One-On-One program, by utilizing instead trained high school students with professional supervision, would provide this intensive level of support for approximately $50 per week per student, a cost that many middle class parents would be able to afford to pay on their own. Trained college students would be able to provide this level of intensive support for approximately $110 per week. In a sense, these figures should really be thought of as $25 per week for high school interns and $60 per week for college interns because there really are two students benefitting whenever we provide a youth with an intern—the youth plus the intern. The intern benefits at least as much as the younger student. High school students, who are bored and can therefore get into trouble, are provided with a meaningful work experience. College students interested in careers as either teachers, police officers, counselors, social workers, psychologists, or psychiatrists, can get real on the job training. If the program prevents just a single person at each high school community from going into a maximum security residential program it would cover the entire community cost of the program for over 200 interns. It is highly likely that the community would actually save a great deal of money while providing a far more effective alternative to the current programs now available and needlessly placing children on toxic psychiatric drugs.

Jeffrey Rubin, PhD, has taught conflict resolution at his alma mater, the University of Minnesota, as well as at other institutions including clinics, correctional facilities, and public schools. Additional professional roles over the years have included counseling and school psychology evaluations. Dr. Rubin publishes a weekly blog titled Name Calling, Insults, and Teasing: A Guide to Anger, Conflict, and Respect that features suggestions for working through conflict and supporting respectful relationships (drjeffreyrubin.wordpress.com). His professional journal publications include “William James and the Pathologizing of Human Experience” and “The Emotion of Anger: Some Conceptual and Theoretical Issues.” He has also authored several novels, including A Hero Grows in Brooklyn and Fights in the Streets, Tears in the Sand.

Martin McGill-February 27th, 2014 at 3:12 pmnone
Comment author #1204 on The One-On-One Program: A Remarkable Alternative to the Psychiatric Drugging of Our Youth by Global Summit on Diagnostic Alternatives

Fab-u-lous! This is an excellent piece of work, and a model which could be successfully replicated in possibly, any culture. I prefer not to work with children and young adults, and I take my hat off to those who do Jeffrey. Your work here is informative, illuminating, and inspiring. As a point of interest for future reference, do you offer conflict resolution training to other therapists? I’d be most interested in hearing you speak if the opportunity ever arose.

Hi Martin McGill. The ideas of the One-On-One Program has come about after 30 years of frustration as I witnessed more and more youth being place on more and more drugs, often many drugs at the same time. I believe there is a far healthier way to address the behavioral and emotional concerns that are being expressed in our schools and neighborhoods. It is heartening to hear from people like yourself and Preteeksha.

With regards to offering conflict resolution training–although I have been devoting myself to writing for the past few years, I’m always open to consider putting together a training program upon some specific request.

Deborah-February 27th, 2014 at 6:45 pmnone
Comment author #1205 on The One-On-One Program: A Remarkable Alternative to the Psychiatric Drugging of Our Youth by Global Summit on Diagnostic Alternatives

Brilliant, exciting, inspiring, hopeful, getting to the real root of the issue. I appreciate your caring and creative thinking! I will imagine this model being widely embraced and implemented in every school and community.

daisy swadesh-March 3rd, 2014 at 2:33 pmnone
Comment author #1214 on The One-On-One Program: A Remarkable Alternative to the Psychiatric Drugging of Our Youth by Global Summit on Diagnostic Alternatives

This is the answer to finding and saving normal! It’s good for kids, good for parents–present and future–it rebuilds communities.
Positive early intervention is what healthy parents do–when they see a problem developing they find ways to help a child grow through it (and grow themselves at the same time).
One-on-one’s low cost makes it financially doable. It’s people intensive–and in working through problems people and groups come together–a worthwhile challenge! It’s like re-starting an ecosystem–a human ecosystem–something that needs to start small and local; eventually it will grow exponentially.

1) It’s good for kids. “At risk” is so much better than “mentally disordered”–it has room for hope. Often kids get in trouble as a cry for help.
2) good for parents–respite care, especially for single mothers in low-income jobs who are struggling and often near crisis–(single fathers too).
3) good for the mentors–as a training ground as future parents and/or professionals working with children. When families were larger and children played together in the neighborhood children used to learn a great deal from older children. Now they’re usually limited to peer groups.
4) Genetically we are designed for small communities. Urban environments bring large numbers of people together in impersonal crowds–and the personal dynamics of small, working, long-term community relationships are lost.

I have seen this work in large extended families, in traditional communities in the U.S. and elsewhere and at the summer camp I attended as a child.

P.S. Why are we stuck in a system that ignores struggling children until they “get into trouble” repeatedly and then labels them “mentally disordered”?
Also, yesterday (3/2/14) the Albuquerque(NM) Journal had a front page article on children killed by their mothers, step-fathers, relatives or mother’s boyfriends and the difficulties faced by the CYFD (Children, Youth and Families Dept.) in responding to these cases. Bureaucratic systems can’t act as parents proactively, but only after the fact of provable violence. I would like to send them a copy of your article if I may.

Hi Deborah, Dave Traxson and Daisy Swadesh, all of your words supporting the ideas for the One-On-One Program are beautiful music to my ears. Daisy, by all means send a copy of my article to anyone you please. Warm Regards to you all.